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Digennaro V, Ferri R, Panciera A, Bordini B, Cecchin D, Benvenuti L, Traina F, Faldini C. Coronal plane alignment of the knee (CPAK) classification and its impact on medial unicompartmental knee arthroplasty: exposing a unexpected external shift of limb mechanical axis in case of prearthritic constitutional valgus alignment: a retrospective radiographic study. Knee Surg Relat Res 2024; 36:14. [PMID: 38555436 PMCID: PMC10981814 DOI: 10.1186/s43019-024-00217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Vitantonio Digennaro
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Riccardo Ferri
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alessandro Panciera
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Davide Cecchin
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Lorenzo Benvenuti
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti D'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Zhang ZH, Qi YS, Wei BG, Bao HRC, Xu YS. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol 2023; 11:1127289. [PMID: 37265991 PMCID: PMC10230366 DOI: 10.3389/fbioe.2023.1127289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/27/2023] [Indexed: 06/03/2023] Open
Abstract
Artificial knee arthroplasty, as the most effective method for the treatment of end-stage joint diseases such as knee osteoarthritis and rheumatoid arthritis, is widely used in the field of joint surgery. At present, Finite element analysis (FEA) has been widely used in artificial knee replacement biomechanical research. This review presents the current hotspots for the application of FEA in the field of artificial knee replacement by reviewing the existing research literature and, by comparison, summarizes guidance and recommendations for artificial knee replacement surgery. We believe that lower contact stress can produce less wear and complications when components move against each other, in the process of total knee arthroplasty (TKA), mobile-bearing prostheses reduce the contact surface stress of the tibial-femoral joint compared with fixed-bearing prostheses, thus reducing the wear of the polyethylene insert. Compared with mechanical alignment, kinematic alignment reduces the maximum stress and maximum strain of the femoral component and polyethylene insert in TKA, and the lower stress reduces the wear of the joint contact surface and prolongs the life of the prosthesis. In the unicompartmental knee arthroplasty (UKA), the femoral and tibial components of mobile-bearing prostheses have better conformity, which can reduce the wear of the components, while local stress concentration caused by excessive overconformity of fixed-bearing prostheses should be avoided in UKA to prevent accelerated wear of the components, the mobile-bearing prosthesis maintained in the coronal position from 4° varus to 4° valgus and the fixed-bearing prosthesis implanted in the neutral position (0°) are recommended. In revision total knee arthroplasty (RTKA), the stem implant design should maintain the best balance between preserving bone and reducing stress around the prosthesis after implantation. Compared with cemented stems, cementless press-fit femoral stems show higher fretting, for tibial plateau bone defects, porous metal blocks are more effective in stress dispersion. Finally, compared with traditional mechanical research methods, FEA methods can yield relatively accurate simulations, which could compensate for the deficiencies of traditional mechanics in knee joint research. Thus, FEA has great potential for applications in the field of medicine.
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Affiliation(s)
- Zi-Heng Zhang
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
- Graduate School, Inner Mongolia Medical University, Hohhot, China
| | - Yan-Song Qi
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Bao-Gang Wei
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Hu-Ri-Cha Bao
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Yong-Sheng Xu
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
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Matziolis G, Jacob B, Eijer H, von Eisenhart-Rothe R, Jacob N. Less soft tissue release in total knee arthroplasty for anteromedial compared to posteromedial knee osteoarthritis. Arch Orthop Trauma Surg 2023; 143:489-493. [PMID: 35037995 PMCID: PMC9886609 DOI: 10.1007/s00402-021-04260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/12/2021] [Indexed: 02/03/2023]
Abstract
In total knee arthroplasty (TKA), the aim of achieving a mechanically straight leg axis as well as symmetrical and equally wide gaps has become established as the gold standard in terms of surgical technique. In contrast to TKA unicompartmental knee arthroplasty (UKA) is performed in anteromedial osteoarthritis (AMOA) and does not normally require releases. This raises the hypothesis whether the type of osteoarthritis (AMOA vs. posteromedial osteoarthritis (PMOA)) determines the requirement for soft tissue releases in TKA.In this retrospective study, 114 patients with medial osteoarthritis of the knee who had been treated with a navigated total knee replacement were consecutively included. On the basis of the preoperative lateral radiographs, the patients were divided into two groups: AMOA and PMOA. The incidence and the extent of releases performed were recorded using the navigation records.Patient-specific data (gender, age) did not differ between the groups (NS). Knees with AMOA presented an overall varus alignment of 5.3 ± 3.5°, knees with PMOA 8.0 ± 4.0° (p < 0.001). 30 cases (44%) had to be released in the AMOA group, compared with 33 cases (72%) in the PMOA group (p = 0.004). In the case of medial release, the extension gap increased 3.3 ± 2.4 mm in the AMOA compared to 5.3 ± 3.7 mm in the PMOA group (p = 0.006). The medial flexion gap was released 2.2 ± 2.6 mm in the AMOA and 2.9 ± 3.0 mm in the PMOA group (p = 0.008).To achieve a neutral mechanical alignment, a release has to be performed due to asymmetry of the extension gap more often if PMOA is present than in AMOA. Surgeons should be prepared to perform more frequent and extensive medial releases in PMOA. Higher constrained implants should be available in case of unintended over release in PMOA.
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Affiliation(s)
- Georg Matziolis
- grid.275559.90000 0000 8517 6224University Hospital Jena, Campus Eisenberg, Orthopaedic Department, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany ,grid.491777.b0000 0004 7589 8636Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Benjamin Jacob
- grid.275559.90000 0000 8517 6224University Hospital Jena, Campus Eisenberg, Orthopaedic Department, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Henk Eijer
- Department of Orthopaedic Surgery, Spital Emmental, Burgdorf, Switzerland
| | - Rüdiger von Eisenhart-Rothe
- grid.6936.a0000000123222966Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany ,grid.491777.b0000 0004 7589 8636Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Nadja Jacob
- grid.275559.90000 0000 8517 6224University Hospital Jena, Campus Eisenberg, Orthopaedic Department, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
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Moretti L, Coviello M, Rosso F, Calafiore G, Monaco E, Berruto M, Solarino G. Current Trends in Knee Arthroplasty: Are Italian Surgeons Doing What Is Expected? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091164. [PMID: 36143840 PMCID: PMC9504315 DOI: 10.3390/medicina58091164] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023]
Abstract
Objectives: The purpose of this study is to evaluate Italian surgeons’ behavior during knee arthroplasty. Materials and Methods: All orthopedic surgeons who specialized in knee replacement surgeries and were members of the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopedic Technologies (SIGASCOT) between January 2019 and August 2019 were asked to complete a survey on the management of knee arthroplasty. Data were collected, analyzed, and presented as frequencies and percentages. Results: One-hundred and seventy-seven surgeons completed the survey and were included in the study. Ninety-five (53.7%) surgeons were under 40 years of age. Eighty-five surgeons (48%) worked in public hospitals and 112 (63.3%) were considered “high volume surgeons”, with more than 100 knee implants per year. Postero-stabilized total knee arthroplasty was the most commonly used, implanted with a fully cemented technique by 162 (91.5%) surgeons. Unicompartmental knee arthroplasty (UKA) was a rarer procedure compared to TKA, with 77% of surgeons performing less than 30% of UKAs. Most common TKA pre-operative radiological planning included complete antero-posterior (AP) weight-bearing lower limb radiographs, lateral view and patellofemoral view (used by 91%, 98.9% and 70.6% of surgeons, respectively). Pre-operative UKA radiological images included Rosenberg or Schuss views, patellofemoral view and magnetic resonance imaging (66.1%, 71.8% and 46.3% of surgeons, respectively). One hundred and thirty-two surgeons (74.6%) included an AP weight-bearing lower limb X-ray one year after surgery in the post-operative radiological follow-up. Furthermore, 119 surgeons (67.2%) did not perform a post-operative patellofemoral view because it was not considered useful for radiological follow-up. There was no uniformity in the timing and features of post-operative follow-up, with 13 different combinations. Conclusions: Italian surgeons perform TKA more commonly than UKA. Pre-operative TKA planning is quite uniform rather than UKA planning. Despite literature evidence, there is no agreement on follow-up. It may be useful to create a uniform checklist, including correct timing and exams needed. This analysis is also part of a society surgical educational project for training doctor.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele Coviello
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Federica Rosso
- Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128 Turin, Italy
| | - Giuseppe Calafiore
- Department of Orthopaedic and Trauma Surgery, Città di Parma Clinic, Piazzale Athos Maestri 5, 43123 Parma, Italy
| | - Edoardo Monaco
- Orthopedic Unit, Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, 00189 Rome, Italy
| | - Massimo Berruto
- Chirurgia Articolare del Ginocchio, ASST Ospedale Gaetano Pini CTO, 20122 Milano, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Holzer LA, Holzer G. The most influential papers in unicompartmental knee arthroplasty. Knee Surg Relat Res 2020; 32:54. [PMID: 33036665 PMCID: PMC7547448 DOI: 10.1186/s43019-020-00072-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Unicompartmental knee arthroplasty (UKA) is a treatment option for anteromedial osteoarthritis of the knee. The number of UKA has been increasing constantly worldwide in recent decades. The aim of this study was to determine the most frequently cited scientific articles addressing this subject and to establish a ranking of the 50 most influential papers. Methods The 50 most cited articles related to UKA were searched in Web of Science® (Clarivate Analytics, Penn., USA) by the use of defined search terms. All types of scientific papers with reference to this topic were ranked according to the absolute number of citations and analyzed for the following characteristics: journal title, year of publication, number of citations, citation density, geographic origin, article type, and level of evidence. Results The 50 most cited articles had up to 453 citations. Most papers were published in the Journal of Bone and Joint Surgery (British volume). More than half of the articles were published in the 2000s and 2010s (n = 30). Ten countries contributed to the top 50 list, with most contributions from the UK (n = 17). Most articles could be attributed to the category of Clinical Science (n = 33), and most reported level IV studies. Conclusion Most of the frequently cited articles in UKA are clinical studies that have a low level of evidence. Few basic scientific studies could be identified, which suggests that most product development is done by commercial companies.
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopedic Surgery, AUVA Trauma Center Klagenfurt, Waidmannsdorferstraße 35, 9020, Klagenfurt am Wörthersee, Austria.
| | - Gerold Holzer
- Department of Orthopedics and Traumatology, Medical University of Vienna, Vienna, Austria
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Koh YG, Nam JH, Chung HS, Lee HY, Kang KT. Morphologic difference and size mismatch in the medial and lateral tibial condyles exist with respect to gender for unicompartmental knee arthroplasty in the Korean population. Knee Surg Sports Traumatol Arthrosc 2020; 28:1789-1796. [PMID: 31263927 DOI: 10.1007/s00167-019-05600-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to characterize the geometry of the proximal tibia in both genders in the Korean population. Anthropometric data on the medial and lateral tibial condyles of the osteoarthritic knees of 149 males and 814 females were obtained using three-dimensional magnetic resonance imaging. METHODS In the medial and lateral proximal tibial condyles, the anteroposterior (AP) dimension, widest dimension (WD) at defined points, and condylar aspect ratio were evaluated. These measurements were compared with similar dimensions of the tibial components from five commonly used unicompartmental knee arthroplasty (UKA) designs in Korea. RESULTS Both the AP dimension and WD in the medial and lateral tibial condyles of the male patients were significantly greater than those of the female patients (P < 0.05). In addition, the AP dimension and WD were greater in the medial than in the lateral tibial condyle (P < 0.05). There was WD overhang in three and two prostheses in the medial and lateral tibial condyles, respectively. A decrease in the condylar aspect ratio with an increasing AP dimension was found in the medial and lateral tibial condyles for both the male and female patients. CONCLUSIONS Smaller medial and lateral tibial condylar dimensions are more frequent in Korean women than in Korean men. This study highlights the finding that conventional UKA designs lead to size mismatch in the Korean population and may indicate an important guideline on proper gender-specific UKA tibial prostheses with different WD/AP dimension aspect ratios. In addition, this study suggests that the shape of the medial tibial plateau is different to that of the lateral plateau, which can lead to a mediolateral overhang for medial UKA in an attempt to optimize the AP coverage. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Seok Chung
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Finite Element Study on the Preservation of Normal Knee Kinematics with Respect to the Prosthetic Design in Patient-Specific Medial Unicompartmental Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1829385. [PMID: 32258105 PMCID: PMC7109557 DOI: 10.1155/2020/1829385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/07/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
Alterations in native knee kinematics in medial unicompartmental knee arthroplasty (UKA) are caused by the nonanatomic articular surface of conventional implants. Technology for an anatomy mimetic patient-specific (PS) UKA has been introduced. However, there have been no studies on evaluating the preservation of native knee kinematics with respect to different prosthetic designs in PS UKA. The purpose of this study was to evaluate the preservation of native knee kinematics with respect to different UKA designs using a computational simulation. We evaluated three different UKA designs: a nonconforming design, an anatomy mimetic design, and a conforming design for use under gait and squat loading conditions. The results show that the anatomy mimetic UKA design achieves closer kinematics to those of a native knee compared to the other two UKA designs under such conditions. The anatomy memetic UKA design exhibited a 0.39 mm and 0.36° decrease in the translation and rotation, respectively, in the swing phase compared with those of the natural knee. In addition, under the gait and squat loading conditions, the conforming UKA design shows limited kinematics compared to the nonconforming UKA design. Our results show that the conformity of each component in PS UKA is an important factor in knee joint kinematics; however, the anatomy mimetic UKA design cannot restore perfect native kinematics.
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Kumar V, Nayak M, Panthee R, Yadav R, Marendupaka S. A Technical Tip to Avert Meniscal Rotation and Dislocation in a Mobile Bearing Unicompartmental Knee Arthroplasty. CASE REPORTS IN ORTHOPEDIC RESEARCH 2020. [DOI: 10.1159/000506762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Oxford (Oxford® partial knee; Biomet) mobile bearing medial unicondylar knee replacement (OUKR) is a preferred choice by surgeons due to minimal blood loss, reduced pain, and better range of motion. Commonly observed complications include aseptic loosening, polyethylene wear, bearing dislocation, and periprosthetic fractures. A bearing dislocation can be prevented by ensuring that there is correct tracking of bearing during the trial reduction as well as no loss of entrapment. We present a case report in a 50-year-old patient undergoing bilateral OUKR wherein it was observed that the meniscal bearing upon the flexion of the knee joint had the tendency to dislocate. Upon revising the vertical tibial recut according to the anterior superior iliac spine, the meniscus was found to have a normal excursion. Mobile bearing dislocation is a unique complication of mobile bearing OUKR. Surgical technique is of paramount importance in ensuring a successful OUKR. The vertical tibial cut is made to accommodate the vertical wall of the tibial component. Meniscal displacement is quite a common complication and can occur due to multiple causes. Inaccurate vertical tibial cut may be one such reason leading to tibial dislocation.
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Influence of Preservation of Normal Knee Contact Stress on Other Compartments with respect to the Tibial Insert Design for Unicompartmental Knee Arthroplasty. Appl Bionics Biomech 2019; 2019:9246379. [PMID: 31827605 PMCID: PMC6885156 DOI: 10.1155/2019/9246379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/02/2019] [Accepted: 10/11/2019] [Indexed: 12/05/2022] Open
Abstract
Recent advances in imaging technology and additive manufacturing have led to the introduction of customized unicompartmental knee arthroplasty (UKA) that can potentially improve functional performance due to customized geometries, including customized sagittal and coronal curvature and enhanced bone preservation. The purpose of this study involved evaluating the biomechanical effect of the tibial insert design on the customized medial UKA using computer simulations. We developed sagittal and coronal curvatures in a native knee mimetic femoral component design. We utilized three types of tibial insert design: flat, anatomy mimetic, and conforming design. We evaluated contact stress on the tibial insert and other compartments, including the lateral meniscus and articular cartilage, under gait and squat loading conditions. For the conforming UKA design, the tibial insert and lateral meniscus exhibited the lowest contact stress under stance phase gait cycle. However, for the conforming UKA design, the tibial insert and lateral meniscus exhibited the highest contact stress under swing phase gait cycle. For the flat UKA design, the articular cartilage exhibited the lowest contact stress under gait and squat loading conditions. The anatomy mimetic UKA design exhibited the most normal-like contact stress on the other compartments under gait and squat loading conditions. The results reveal the importance of conformity between the femoral component and the tibial insert in the customized UKA. Based on the results on the femoral component as well as the tibial insert in the customized UKA, the anatomy mimetic design preserves normal knee joint biomechanics and thus may prevent progressive osteoarthritis of the other knee compartments.
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Park HG, Yu KW, Kim SH, Lee DH. The effect of C-arm fluoroscope on unicompartmental knee replacement arthroplasty. J Orthop 2018; 15:802-807. [PMID: 30127588 DOI: 10.1016/j.jor.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/16/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose The aim of this study was to identify the effectiveness of C-arm fluoroscope in unicompartmental knee replacement arthroplasty through the clinical and radiologic results. Materials and methods We investigated the 33 cases of unicompartmental knee replacement arthroplasty in 31 patients who diagnosed degenerative arthritis of knee between February 2011 and March 2014. We divided 2 groups, one is 15 cases using C-arm fluoroscope during operation (group A), the other is 18 cases not using that (group B). We measured femoro-tibial angle (FTA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), femoral component coronal rotation angle (FCRA) by simple X-ray. We evaluated femur and tibia varus/valgus mismatch and posterior slope mismatch by above parameters after operation. And also we evaluated clinically by knee and functional score. Results In group A, FTA average changes from -0.6° to 6.1°, MPTA changes from 84.5° to 87.6°, PTSA changes from 6.2° to 5.2° through operation. In group B, FTA changes from -0.4° to 5.8°, MPTA changes from 84.7° to 87.1°, PTSA changes from 6.3° to 5.5°, and FCRA is 0.6° in A group, 0.4° in B group after operation. The tibial varus/valgus mismatch cases after operation (nl.:87 ± 3°) was 1 in group A, 5 in group B. Post. slope mismatch cases after operation (nl.:7 ± 3°) was 1 in group A, 1 in group 31 B. All cases in both A and B group were not included in femoral varus/valgus mismatch (nl.:0 ± 3°) after operation. In group A, Knee score improved from 56.3 to 90.7, Functional score from 54.3 to 86.9 through operation. In group B, Knee score improved from 54.9 to 89.8, Functional score from 52.8 to 84.6. Conclusion There was no statistically significant difference in radiologic and clinical results between group A and B, but the number of tibial varus/valgus mismatch case were fewer in fluoroscope guided group. Sowe consider that thefluoroscope is helpful for tibial cuttingin unicompartmental knee replacement arthroplasty.
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Affiliation(s)
- Hee-Gon Park
- Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Kun-Woong Yu
- Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Sung-Hyun Kim
- Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Republic of Korea
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Han SB, Kyung HS, Seo IW, Shin YS. Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy. Medicine (Baltimore) 2017; 96:e9268. [PMID: 29390376 PMCID: PMC5815788 DOI: 10.1097/md.0000000000009268] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, it is unclear whether HTO or UKA leads to better clinical outcomes and lower complication rates. This meta-analysis compared the clinical outcomes and complications of HTO and UKA in patients with medial knee OA. METHODS All studies comparing the functional outcome, postoperative pain, revision rate to total knee arthroplasty (TKA), postoperative complications, postoperative velocity, and postoperative range of motion (ROM) as assessed with various measurement tools in patients with medial knee OA treated with HTO or UKA were included. RESULTS Sixteen studies were included in the meta-analysis. The proportion of patients who underwent revision to TKA (OR 1.56, 95% CI: 0.61-3.98; P = .35) did not differ significantly between HTO and UKA. In contrast, functional outcome (OR 0.47, 95% CI: 0.24 to 0.95; P = .04), postoperative pain (OR 0.28, 95% CI: 0.12 to 0.62; P = .002), postoperative complications (OR 2.48, 95% CI: 1.26 to 4.90; P = .009), postoperative velocity (95% CI: -0.11 to -0.00; P = .03), and postoperative ROM (95% CI: 2.02 to 15.23; P = .01) were significantly different between the 2 groups. CONCLUSIONS There were no significant differences in the revision rate to TKA between HTO and UKA. However, results from subgroup analyses suggested that opening-wedge HTO resulted in a lower revision rate to TKA than did UKA, whereas closing-wedge HTO resulted in a higher revision rate to TKA than did UKA. In addition, UKA resulted in significantly better functional outcomes and postoperative velocity, along with less postoperative pain, fewer postoperative complications, and lower postoperative ROM. Based on the findings of current meta-analysis, UKA appears to be as efficacious and safe as HTO in the treatment of medial knee OA.
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - Hee-Soo Kyung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu
| | - In-Wook Seo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Matsuzaki T, Matsumoto T, Muratsu H, Ishida K, Takayama K, Nagai K, Nakano N, Nishida K, Kuroda R, Kurosaka M. The contribution of intraoperative medial compartment stability to post-operative knee flexion angle in unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:272-276. [PMID: 25536952 DOI: 10.1007/s00167-014-3493-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Given the knee kinematics and soft tissue balance in unicompartmental knee arthroplasty (UKA), it was hypothesised that intraoperative medial compartment stability will result in good functional outcome. The purpose of this study was to test the influence of soft tissue balance on post-operative knee flexion in UKA. METHODS The influence of soft tissue balance on post-operative knee flexion in UKA was first examined retrospectively by using a newly developed tensor device in 30 consecutive patients diagnosed with either isolated medial compartmental osteoarthritis or idiopathic necrosis. The intraoperative component gap of the medial compartment was measured by using the tensor while applying a 20-lb joint distraction force at 0°, 10°, 30°, 45°, 60°, 90°, 120°, and 135° of knee flexion, with calculation of the joint looseness. Correlations between the soft tissue parameters and post-operative knee flexion angles were analysed 1 year after surgery. RESULTS The post-operative knee flexion angle was negatively correlated with the component gap at 45°, 60°, and 90° of flexion (R = -0.41, P < 0.05; R = -0.44, P < 0.05; and R = -0.44, P < 0.05, respectively). Furthermore, the post-operative knee flexion angle was negatively correlated with joint looseness at 45°, 60°, and 90° of flexion (R = -0.40, P < 0.05; R = -0.41, P < 0.05; and R = -0.36, P < 0.05, respectively). CONCLUSIONS The intraoperative medial compartment stability of knee flexion in midrange resulted in increasing post-operative knee flexion angle in UKA. Medial soft tissue release should be minimised, and assessment of soft tissue balance using a tensor can be performed to predict the post-operative knee flexion angle during surgery for UKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tokio Matsuzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Hyogo, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Lunebourg A, Parratte S, Galland A, Lecuire F, Ollivier M, Argenson JN. Is isolated insert exchange a valuable choice for polyethylene wear in metal-backed unicompartmental knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2016; 24:3280-3286. [PMID: 25343874 DOI: 10.1007/s00167-014-3392-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/15/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to evaluate the clinical outcome and survival rate after isolated liner exchange for polyethylene (PE) wear in well-fixed metal-backed fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS Twenty medial UKAs in 19 patients [mean age 68.7 years ± 8.7 (range 48.5-81.5 years)] operated on for a direct PE liner exchange after isolated PE wear between 1996 and 2010 in two institutions were retrospectively reviewed. The mean delay between the index operation and revision was 8.2 years ± 2.6 (range 4.8-12.8 years). A four-level satisfaction questionnaire was used, and clinical outcomes were assessed using Knee Society scores (KSS) and range of motion (ROM) evaluation. Radiological evaluation analysed the position of the implants and progression of the disease. Survival rate of the implants was evaluated using Kaplan-Meier analysis with two different end-points. RESULTS At the last follow-up [mean 6.8 years ± 5.2 (range 1.1-15.9 years)], 15 patients (79 %) were enthusiastic or satisfied. KSS improved from 73.4 to 86.4 points (p = 0.01) and function from 58.9 to 89.2 points (p < 0.001). ROM at last FU was 126.5° ± 10.3°. The survival rate at 12 years considering "revision for any reason" as the end-point was 71.3 ± 15.3 %, and the survival rate at 12 years considering "revision of UKA to TKA" as the end-point was 93.3 ± 6.4 %. CONCLUSION Isolated liner exchange for PE wear in well-fixed metal-backed fixed-bearing UKA represents a valuable treatment option in selective patients with durable improvement of clinical outcomes without compromising any future revision. LEVEL OF EVIDENCE Retrospective therapeutic study, Level IV.
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Affiliation(s)
- Alexandre Lunebourg
- Department of Orthopedic Surgery APHM, Institute for Locomotion (IML), Sainte Marguerite Hospital, 13009, Marseille, France.,ISM UMR 7287, Aix-Marseille University, CNRS, 13284, Marseille, France
| | - Sébastien Parratte
- Department of Orthopedic Surgery APHM, Institute for Locomotion (IML), Sainte Marguerite Hospital, 13009, Marseille, France. .,ISM UMR 7287, Aix-Marseille University, CNRS, 13284, Marseille, France.
| | - Alexandre Galland
- Department of Orthopedic Surgery APHM, Institute for Locomotion (IML), Sainte Marguerite Hospital, 13009, Marseille, France.,ISM UMR 7287, Aix-Marseille University, CNRS, 13284, Marseille, France
| | - François Lecuire
- Department of Orthopedic Surgery, Hôpital Renée Sabran, Giens, 83406, Hyeres, France
| | - Matthieu Ollivier
- Department of Orthopedic Surgery APHM, Institute for Locomotion (IML), Sainte Marguerite Hospital, 13009, Marseille, France.,ISM UMR 7287, Aix-Marseille University, CNRS, 13284, Marseille, France
| | - Jean-Noël Argenson
- Department of Orthopedic Surgery APHM, Institute for Locomotion (IML), Sainte Marguerite Hospital, 13009, Marseille, France.,ISM UMR 7287, Aix-Marseille University, CNRS, 13284, Marseille, France
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15
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Akan B, Yildirim T, Karaguven D. Medial femoral condyle fracture after cementless unicompartmental knee replacement: a rare complication. Knee 2013. [PMID: 23178111 DOI: 10.1016/j.knee.2012.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This case report describes a rare complication of unicompartmental knee arthroplasty. Femoral fracture after TKR is a serious and relatively common problem, but to the best of our knowledge, only one case of femoral condylar fracture after UKA has been reported thus far.
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Affiliation(s)
- Burak Akan
- Department of Orthopedics and Traumatology, Ufuk University Faculty of Medicine, Ankara, Turkey.
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16
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Spontaneous relocation of a posterior dislocation of mobile bearing in a medial unicompartmental knee replacement. Case Rep Orthop 2012; 2012:230430. [PMID: 23259116 PMCID: PMC3504211 DOI: 10.1155/2012/230430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/09/2012] [Indexed: 11/18/2022] Open
Abstract
We describe a case of spontaneous relocation of a posterior dislocation of the mobile bearing in a medial unicompartmental knee replacement, prior to surgical intervention. We are unaware of any similar cases in the published literature. This paper highlights some clinical issues around this type of dislocation.
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17
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Berend KR, Kolczun MC, George JW, Lombardi AV. Lateral unicompartmental knee arthroplasty through a lateral parapatellar approach has high early survivorship. Clin Orthop Relat Res 2012; 470:77-83. [PMID: 21822570 PMCID: PMC3237974 DOI: 10.1007/s11999-011-2005-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The literature suggests lateral unicompartmental knee arthroplasties are associated with low revision rates. However, there are fewer reports describing techniques for lateral unicompartmental arthroplasty and whether technique influences ROM and function compared to reports for medial unicompartmental arthroplasty. QUESTIONS/PURPOSES We report our indications for lateral unicompartmental arthroplasty, how we perform this procedure, and the subsequent Knee Society scores, ROM, and revision and reoperation rates. PATIENTS AND METHODS From a retrospective review of electronic records from 2004 through 2008, we identified 93 patients who had 100 lateral unicompartmental arthroplasties. Indications were complete lateral bone-on-bone arthrosis with a correctible deformity and maintenance of the medial joint space on varus stress radiographs or isolated lateral disease by diagnostic arthroscopy. Average age was 68 years. Seventy percent of patients were women. At followup, we obtained Knee Society scores and ROM. Minimum followup was 24 months (average, 39 months; range, 24-81 months). RESULTS At followup, Knee Society scores averaged 46 for pain, 94 for clinical, and 89 for function, and ROM averaged 124°. Three patients had reoperations: one an open reduction and internal fixation for fracture at 2 years postoperatively, one an arthroscopy for a medial meniscal tear, and one a revision for pain. CONCLUSIONS Based on our observations, we believe complete cartilage loss laterally and correctible deformity with maintenance of the medial joint on varus stress radiographs are reasonable indications for lateral unicompartmental arthroplasty. We recommend a lateral parapatellar approach can be utilized. The early reoperation and revision rates were low.
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Affiliation(s)
- Keith R. Berend
- Department of Orthopaedics, Ohio State University, Columbus, OH USA ,Mount Carmel Health System, New Albany, OH USA ,Joint Implant Surgeons Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
| | - Michael C. Kolczun
- Kolczun and Kolczun Orthopaedic Associates, Lorain, OH USA ,Cleveland Clinic Foundation, Lorain, OH USA
| | - Joseph W. George
- Kolczun and Kolczun Orthopaedic Associates, Lorain, OH USA ,Cleveland Clinic Foundation, Lorain, OH USA
| | - Adolph V. Lombardi
- Department of Orthopaedics, Ohio State University, Columbus, OH USA ,Mount Carmel Health System, New Albany, OH USA ,Joint Implant Surgeons Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA ,Department of Biomedical Engineering, Ohio State University, Columbus, OH USA
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18
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Down C, Xu Y, Osagie LE, Bostrom MPG. The lack of correlation between radiographic findings and cartilage integrity. J Arthroplasty 2011; 26:949-54. [PMID: 21144698 DOI: 10.1016/j.arth.2010.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 09/17/2010] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty is a common treatment of osteoarthritis, although unicompartmental knee arthroplasties are frequently used to retain unaffected compartments. Joint space width (JSW) is a major factor in determining treatment. We examined the relationship between JSW and cartilage quality in 60 patients undergoing total knee arthroplasty to assess its accuracy in representing cartilage degradation. Radiographic JSW was recorded, whereas the unaffected compartment of each tibial plateau was examined postoperatively using Collins, Mankin, and Kellgren and Lawrence scores. No correlation was seen between visual or histologic grading and JSW. Histology more accurately represented cartilage quality, yet it is impractical to obtain preoperatively; thus, JSW is the main mode of assessment. However, using JSW solely to indicate unicompartmental knee arthroplasty may overlook disease in apparently unaffected compartments.
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Affiliation(s)
- Carrie Down
- Laboratory for Mineralized Tissue Research, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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19
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Maduekwe UI, Zywiel MG, Bonutti PM, Johnson AJ, Delanois RE, Mont MA. Scientific evidence for the use of modern unicompartmental knee arthroplasty. Expert Rev Med Devices 2010; 7:219-39. [PMID: 20214428 DOI: 10.1586/erd.09.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unicompartmental knee arthroplasty as a surgical treatment for monocompartmental knee arthritis remains a controversial procedure with questions surrounding the benefits and survivorship of the procedure versus osteotomies or total knee arthroplasties. The authors, by examining the complete body of literature for scientific evidence concerning the procedure, will describe the history of usage of these prostheses, their rationale for usage, modern devices and their results, and why they may have advantages as a treatment modality for monocompartmental knee arthritis. Outcomes of current unicompartmental designs will be presented and evaluated to determine which aspects of the design and patient selection technique are associated with success or failure. Commonly asked questions regarding the use of these devices will be addressed. The authors will also describe some potential modifications that might affect the use of these components in the future, including minimally invasive procedures and robotics, and how these devices may change over the next 5 years.
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Affiliation(s)
- Uma I Maduekwe
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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20
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Bruni D, Iacono F, Russo A, Zaffagnini S, Marcheggiani Muccioli GM, Bignozzi S, Bragonzoni L, Marcacci M. Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 2010; 18:710-7. [PMID: 19763541 DOI: 10.1007/s00167-009-0895-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Accepted: 08/01/2009] [Indexed: 10/20/2022]
Abstract
We performed a retrospective clinical and radiographic evaluation of 83 nonconsecutive patients operated in our institute between February 1996 and March 2003 with a mean follow-up of 60 months to assess the efficiency of unicompartmental knee replacement (UKR) performed with a minimally invasive technique. The aim of this study was to correlate the clinical outcome with the pre- and post-operative alignment and with implant positioning on coronal and sagittal plane. Eighty-three nonconsecutive patients (60 males, 23 females) underwent cemented UKR (De Puy Preservation Uni with all-poly tibial component), for both medial OA (80 patients) and AVN of the medial femoral condyle (3 patients). All patients were available at final follow-up evaluation, and they all presented an evident varus alignment at pre-operative clinical and radiographic evaluation. At radiographic measurement, we considered a knee with femoro-tibial angle (FTA) > 175 degrees as varus knee, 170 degrees < FTA < 175 degrees as normal knee and a knee with a FTA < 170 degrees as a valgus knee. Moreover, we considered a tibial plateau angle (TPA) > 90 degrees for valgus knee and a TPA < 90 degrees for varus knee. According to Hospital for Special Surgery (HSS) scoring system, at a mean follow-up of 60 months, 61 (74%) cases were excellent (100-85 points), 15 (18%) cases were good (84-70 points) and 7 cases (8%) had fair results (<70 points). In our series, patients with an excellent clinical result presented a mean varus deformity of 7.2 degrees (3.6 degrees-10.8 degrees) pre-operatively. According to literature, we demonstrated that a small amount of undercorrection with a small amount of residual varus deformity of 3 degrees-5 degrees is the goal to be reached in order to avoid both rapid degeneration of the nonreplaced compartment and the premature loosening of the replaced compartment. We performed a mean axial correction of 5 degrees (SD 3.9 degrees), leaving a mean axial varus deformity of 2.2 degrees in the excellent group. In our series, the group with excellent results also showed a post-operative PTS of 7 degrees (2.4 degrees-11.6 degrees), while mean pre-operative PTS was 6.5 degrees (2.7 degrees-10.3 degrees). In this study, results have shown that minimally invasive UKR producing a small amount of varus undercorrection in selected patients with medial tibio-femoral osteoarthritis or moderate avascular necrosis of the medial femoral condyle provides excellent clinical and functional results. Overcorrection of varus malalignment with a UKR may produce both rapid degeneration of the lateral tibio-femoral compartment and the early failure of the replaced compartment.
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Affiliation(s)
- Danilo Bruni
- Division of Orthopaedics and Traumatologic Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
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21
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Walker PS, Yildirim G, Arno S, Heller Y. Future directions in knee replacement. Proc Inst Mech Eng H 2010; 224:393-414. [PMID: 20408486 DOI: 10.1243/09544119jeim655] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of artificial joints for the treatment of osteoarthritis is expected to expand considerably over the next decade. While newer technologies can offer yet further improvements in total knee systems, implementation will be strongly affected by the need to satisfy apparently competing requirements. Patients expect quicker rehabilitation, improved performance, and lifelong durability; on the other hand, economic constraints require a reduction in cost for each procedure, as well as early intervention and preventative measures, while there is increased pressure from health care systems to use evidence-based medicine as the standard of choice for implants and techniques. The success of a knee replacement depends on the design itself, the surgical technique, the rehabilitation, and, not least, the patient. The major goal of the implant design can be redefined as a restoration of normal knee mechanics, whether by maximum preservation of tissues, or by guiding surfaces that replace their function. Surgical technique needs to be less invasive but achieve optimal patient-specific alignment and soft tissue balancing. Rehabilitation procedures must achieve the expectations of realistic patients. Testing and evaluation methods need to be upgraded for enhanced predictability. This paper discusses current trends and future possibilities to address this expansive scope of design criteria.
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Affiliation(s)
- P S Walker
- Laboratory for Minimally-Invasive Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10010, USA.
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22
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Steklov N, Slamin J, Srivastav S, D'Lima D. Unicompartmental knee resurfacing: enlarged tibio-femoral contact area and reduced contact stress using novel patient-derived geometries. Open Biomed Eng J 2010; 4:85-92. [PMID: 20461223 PMCID: PMC2866246 DOI: 10.2174/1874120701004010085] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 02/02/2010] [Accepted: 02/10/2010] [Indexed: 11/22/2022] Open
Abstract
Advances in imaging technology and computer-assisted design (CAD) have recently enabled the introduction of patient-specific knee implant designs that hold the potential to improve functional performance on the basis of patient-specific geometries, namely a patient-specific sagittal and coronal curvature, as well as enhanced bone preservation. The objective of this study was to investigate the use of a novel implant design utilizing a patient specific sagittal J-curve on the femoral component combined with a novel constant, patient-derived femoral coronal curvature and to assess tibio-femoral contact area and contact stress on a femur matched curved tibial polyethylene insert. Mean contact area and standard deviations were 81+/-5, 96+/-5 and 74+/-4 mm(2) for the heel strike, toe off and mid-stance positions, respectively. Mean contact stress and standard deviations were 23.83+/-1.39, 23.27+/-1.14 and 20.78+/-0.54 MPa for the heel strike, toe off and mid-stance positions, respectively. Standard deviations of the measurements were small, not exceeding 6-7% confirming the consistency of loading conditions across different flexion angles. The results were comparable to those reported for standard, off-the-shelf fixed-bearing implants with paired femoral and tibial geometries. These data show that a constant coronal curvature can be applied to a patient-specific implant by measuring coronal curvatures across the femoral condyle in each patient and by deriving an average curvature. This novel approach combines unique benefits of patient-specific geometry with proven design concepts for minimizing polyethylene wear.
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Affiliation(s)
- Nick Steklov
- Shiley Center for Orthopedic Research and Education Center (SCORE), 11025 N. Torrey Pines Road, Suite 140, LaJolla, CA, 92037, USA
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Early complications after minimally invasive mobile-bearing medial unicompartmental knee arthroplasty. J Arthroplasty 2009; 24:1281-4. [PMID: 19729271 DOI: 10.1016/j.arth.2009.07.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 07/13/2009] [Indexed: 02/01/2023] Open
Abstract
The purpose of this article is to review the early complications of minimally invasive mobile-bearing unicompartmental knee arthroplasty by analyzing the first 100 consecutive cases. All cases were medial unicompartmental arthroplasties with a follow-up of at least 24 months (range, 24-51 months). Seven revision procedures were performed due to 2 fractures of the medial tibial plateau, 1 loosening of the femoral component, and 4 dislocations of the meniscal bearing. The early results as determined by The Knee Society scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and postoperative range of motion were satisfactory. However, there exists a high rate of early failures, which occurred during the initial learning curve. Therefore, surgeons must be aware that in order to minimize these complications, attention to detail is mandatory.
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24
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Kim KT, Lee S, Cho KH, Kim KS. Fracture of the medial femoral condyle after unicompartmental knee arthroplasty. J Arthroplasty 2009; 24:1143.e21-4. [PMID: 18835689 DOI: 10.1016/j.arth.2008.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 09/05/2008] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic fracture is a relatively rare but well-recognized complication after knee joint arthroplasty. We experienced a case of medial femoral condylar fracture among 700 cases of unicompartmental knee arthroplasty (UKA). The patient was a 56-year-old woman who underwent minimally invasive UKA for medial osteoarthritis of the knee. A displaced medial femoral condylar fracture occurred 3 years after UKA. A closed reduction and percutaneous fixation using 3 cannulated cancellous screws was performed. Union of the fracture was achieved, and a full recovery of knee motion was gained after 3 months. The Knee Society knee and function scores were 87 and 80, respectively, at the 2-year follow-up. They were the same as the scores before the fracture took place, and there was no evidence of component loosening or ligament instability.
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Affiliation(s)
- Kyung Tae Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, South Korea
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25
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Fitz W. Unicompartmental knee arthroplasty with use of novel patient-specific resurfacing implants and personalized jigs. J Bone Joint Surg Am 2009; 91 Suppl 1:69-76. [PMID: 19182028 DOI: 10.2106/jbjs.h.01448] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This paper describes the surgical technique with a patient-specific resurfacing unicompartmental knee arthroplasty. The patient-specific implant is currently designed on the basis of data from preoperative computed tomography. The implant is provided with a set of patient-specific, disposable cutting jigs. Biomechanical and anatomic axes are factored into jigs from a scan obtained through the hip, knee, and ankle, effectively achieving pre-navigation of the cut planes without the need for a navigation system. The surgical technique is reduced to five simple, reproducible steps. After removing the articular cartilage, the knee is balanced to determine the correct amount of tibial resection; this is followed by femoral preparation, verification of balancing and tibial preparation, and trial and cementing of the implant. The introduction of personalized three-dimensional image-derived resurfacing implants, as well as personalized single-use instrumentation, has the potential to change the common surgical practice of unicompartmental knee arthroplasty. Patient-specific resurfacing implants enable a femoral bone-preserving approach and enhance cortical bone support on the tibia, overcoming critical design limitations of commercial off-the-shelf implants. Patient-specific resurfacing implants can restore normal anatomy, the position of the joint line, and normal joint function, with the potential to result in more normal knee kinematics.
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Affiliation(s)
- Wolfgang Fitz
- Orthopedic and Arthritis Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, 850 Boylston Street, Chestnut Hill, MA 02467, USA.
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26
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Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G. Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 2007; 77:214-21. [PMID: 17388822 DOI: 10.1111/j.1445-2197.2007.04021.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA) and high tibial osteotomy (HTO) may all be used to treat unicompartmental osteoarthritis, but they are often used for different patient groups. However, there is considerable overlap in indications for all three options. The aim of this review was to assess the safety and efficacy of UKA compared with TKA and HTO in unicompartmental osteoarthritis. Studies that compared UKA with either TKA or HTO were identified and included for review. For knee function and postoperative pain, UKA appeared similar to TKA and HTO at 5 years follow up. Range of motion was better in UKA compared with TKA. Complication rates after UKA and TKA appeared similar, although deep vein thrombosis was reported more often after TKA. There were more complications after HTO than UKA. Survival of UKA prostheses was approximately 85-95%, compared with at least 90% for TKA at 10 years follow up. Survivorship for HTO appeared to be less than 85%. It was not clear whether there were more revisions after UKA than TKA, but there appeared to be fewer revisions in UKA compared with HTO. UKA is considered at least as safe as TKA and HTO. For function, UKA appears to be at least as efficacious as TKA and HTO. The survival of UKA compared with TKA and HTO cannot be determined based on the available evidence.
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Affiliation(s)
- Tabatha Griffin
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, SA, Australia
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Abstract
UNLABELLED As the number of unicompartmental knee arthroplasties performed continues to rise, so too will the number of failures. In order to justify its continued use, conversion to total knee arthroplasty must be evaluated. From 1993-2004, 22 consecutive knees from 18 patients with a failed unicondylar knee arthroplasty underwent conversion to total knee arthroplasty. The most common modes of failure were polyethylene wear (12 patients), loosening of the femoral (4 patients) or tibial component (3 patients), and osteoarthritis progression (3 patients). All patients were converted to primary cruciate retaining components. Twenty-seven percent of patients had contained defects on the femoral condyle that required bone graft. No femoral stems or metal augmentation were required. Forty-five percent of patients had contained defects on the tibia that required bone graft. Metal wedge augmentation was required in five knees (23%), and stems were used in two patients. Sixteen of 22 knees (73%) were followed for an average of 64.5 months. Knee Society knee scores and functional scores at latest followup were 93 and 78, respectively. Conversion of a failed unicondylar knee arthroplasty to a total knee arthroplasty is technically demanding, but may be done successfully with careful preoperative planning and possible need for revision techniques. LEVEL OF EVIDENCE Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bryan D Springer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Abstract
The knee is a frequently injured joint and, thus, a common focus of operative intervention. As operative techniques and imaging modalities evolve, radiologists must be aware of the expected postoperative appearance after knee surgeries that are performed commonly and also must be comfortable recognizing complications encountered commonly in the immediate and delayed postoperative period. Drawing on the large amount of attention this subject has received of late in the radiologic and orthopedic literature, this article reviews the knee surgeries performed most commonly and the expected normal and most frequently encountered abnormal postoperative imaging findings with an emphasis on MR imaging.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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Berend KR, Lombardi AV, Mallory TH, Adams JB, Groseth KL. Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity. Clin Orthop Relat Res 2005; 440:60-6. [PMID: 16239785 DOI: 10.1097/01.blo.0000187062.65691.e3] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED There has been increasing use of and expanding indications for unicompartmental knee arthroplasty using minimally invasive techniques. We sought to define contraindications by examining failures. We retrospectively reviewed the early results of a consecutive series of minimally invasive medial unicompartmental knee arthroplasty using two implant designs. Seventy-nine consecutive unicompartmental knee arthroplasty cases (48 instrumented and 31 noninstrumented) with minimum 2-year followup were reviewed. Patients with radiographic involvement with or without pain referable to the lateral compartment or to the patellofemoral joint were not considered candidates. Failure was defined as revision or pending revision. The average followup was 40.2 months. There were 16 failures (six tibial loosening, three plateau fracture, four persistent medial pain, one progressive arthritis, and two sepsis). Age, gender, disease severity and implant design did not predict failure. Body mass index greater than 32 did predict failure and was associated with a reduction in survivorship by log-rank and Wilcoxon analyses. These results show reliable success if obesity is considered a contraindication and technical errors resulting in fracture are eliminated. Better defining the ideal candidate for unicompartmental knee arthroplasty, with obesity remaining a contraindication, will make this a more predictable and reliable procedure. LEVEL OF EVIDENCE Prognostic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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Miller TT. Imaging of knee arthroplasty. Eur J Radiol 2005; 54:164-77. [PMID: 15837396 DOI: 10.1016/j.ejrad.2005.01.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 01/24/2005] [Accepted: 01/28/2005] [Indexed: 12/19/2022]
Abstract
Knee replacement surgery, either with unicompartmental or total systems, is common. The purpose of this manuscript is to review the appearance of normal knee arthroplasty and the appearances of complications such as infection, polyethylene wear, aseptic loosening and particle-induced osteolysis, patellofemoral abnormalities, axial instability, and periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help the radiologist in the diagnostic evaluation of the patient with a painful knee arthroplasty.
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Affiliation(s)
- Theodore T Miller
- Department of Radiology, North Shore University Hospital, 825 Northern Blvd., Great Neck, NY 11021, USA.
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